Acute oxygen therapy: a cross-sectional study of prescribing practices at an English hospital immediately before COVID-19 pandemic

ABSTRACT

Background

Approximately 14% of UK hospital in-patients receive supplemental oxygen therapy, only 57% have valid prescriptions. Oxygen must be optimally prescribed to ensure maximal therapeutic response whilst minimizing adverse outcomes (including fatality). This study investigates prescription compliance.

Methods

All adults admitted to medical wards (18 February to 3 March 2020) were included. Analyses present proportions, descriptive statistics, and hypothesis testing. Ethical approval was unnecessary for this audit.

Results

Of the 636 patients admitted, 66 (10%) were receiving oxygen therapy. Ages ranged from 34 to 100 years with 36 (54.5%) males and 30 (45.5%) females. The prescription was not documented in the oxygen section of the drug chart (n = 37, 56.1%, p = 0.389), nor did it have the physicians signature (n = 40, 60.6%, p = 0.110) nor date (n = 46, 69.7%, p = 0.002). Thirteen chronic obstructive pulmonary disease (COPD) patients (19.7%) were at risk of hypercapnic failure (p = 1.582x10⁻⁶). Target oxygen saturation (SpO2) range had been documented for 30 (45.5%) patients. A target SpO2 range of 88–92% was documented for 9 patients (13.6%), a 94–98% range documented for 11 patients (16.7%). All patients had an invalid prescription.

Conclusion

We present real-world practice in naturalistic settings, immediately before pandemic-lockdown. Enhanced compliance is advocated to reduce risks of harm and mortality.

KEYWORDS:

• Oxygen
• hypercapnia
• inpatients
• oxygen inhalation therapy
• oximetry
• hypoxia
• pulmonary disease
• chronic obstructive
• dyspnea
• iatrogenic disease

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Acknowledgments

We would like to thank staff at East Surrey hospital, part of the Surrey and Sussex Healthcare NHS Trust in England. We extend thanks to Dr Rohit Swarnkar at Weill-Cornell hospital, New York, USA for considering the reasons behind prescription-writing non-compliance.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

RS (first supervisor) & EC were involved in the conception and design, or analysis and interpretation of the data; RS & EC drafted the paper and RB (second supervisor) revised it critically for intellectual content, conducted statistical analysis; and the final approval of the version to be published; and that all authors agree to be accountable for all aspects of the work.

Ethical approval

As this was clinical audit, ethical approval was not required as confirmed by The Medicines Research Council and the Health Research Authority. The clinical audit was conducted according to the principles of the World Medical Association Declaration of Helsinki.[22]

Additional information

Funding

Funding for this study was provided by the University of Brighton.